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This is a duplex Doppler study in a patient with left carotid bruit. The patient has hypertension, elevated cholesterol, diabetes and history of radiation 8 years ago for laryngeal carcinoma. In order to get the quiz correct, you have to identify the 3 findings that are present in this study.

Caption:Transverse scan of the left CCA

Description:There is an echogenic plaque present in the left CCA causing a reduction in the luminal diameter by at least 50%.

Caption:Transverse scan of the right CCA

Description:The right CCA is completely occluded.

Caption:Sagittal scan of the right CCA

Description:No flow is detected in the right CCA, which is occluded in its entire course.

Caption:Scan at the level of the right carotid bifurcation

Description:Both the right ECA and ICA show flow within their lumen, however flow is noted to be in the opposite direction.

Caption:Spectral Doppler analysis of right ICA

Description:A normal arterial waveform is exhibited by the right ICA.

Caption:Spectral Doppler analysis of right ECA

Description:There is reversal of flow in the right ECA; however a normal arterial waveform is noted.

Differential Diagnosis

1. Complete occlusion right common carotid artery2. Reversal of flow in the right ECA3. Plaque in the left common carotid artery

Final Diagnosis

1. Complete occlusion right common carotid artery2. Reversal of flow in the right ECA3. Plaque in the left common carotid artery

Follow Up

A CT angiogram was performed which confirmed the diagnosis. There was reversal of flow in the right ECA as the right ICA was fed by the right ECA.

Left dural arterio-venous malformationThis is the scan of the neck in a 65-year-old woman with complaints of audible bruits in the left ear and papilledema. She has a past history of left Sylvian fissure meningioma.